Cronobacter Infection

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Cronobacter Infection

Pathophysiology

Cronobacter multi-species complex (formerly Enterobacter sakazakii) is a group of gram-negative bacteria that exists in the environment and which can survive in very dry conditions. The natural habitat for Cronobacter is not known. It has been found in a variety of dry foods, including powdered infant formula, skimmed milk powder, herbal teas, and starches. It has also been found in wastewater. Cronobacter illnesses are rare, but they are frequently lethal for infants and can be serious among people with immunocompromising conditions and the elderly.

Treatment

Infants suspected of having Cronobacter sepsis or meningitis should undergo a full clinical evaluation for sepsis, including blood culture, urine culture, and cerebrospinal fluid culture, and should be given empiric therapy for sepsis immediately. Antimicrobial sensitivity patterns of Cronobacter isolates should be determined because multidrug-resistant strains have been reported. Brain imaging studies of infants with meningitis can help detect brain abscesses and other complications. People with urinary tract infections or serious wound infections should also be treated with antibiotics. If a patient is colonized, rather than infected, with Cronobacter, treatment is not needed.

Major research on disease

Current research on E. sakazakii focuses on the elimination of this coliform from PIF. Investigations into thermal resistance, osmotic tolerance, exopolysaccharide production, and pathogenicity, among others, have been performed, and attempts have been made to identify environmental reservoirs. Only 1 study has suggested the possible existence of an enterotoxin produced by E. sakazakii on the basis of an animal model. Other virulence factors remain to be identified. Furthermore, why infection can occur in all age groups but is more frequent among full-term infants and neonates remains to be understood.

Statistics

The occurrence of Cronobacter spp. was investigated in 1,012 samples of dehydrated rice powder collected from 14 manufacturers in China during 2010 to 2012. The isolates were identified using fusA allele sequencing and subtyped using pulsed-field gel electrophoresis. Seventy-six samples (7.5%) contained Cronobacter spp. The prevalence among manufacturers ranged from 0-28.8%. The 76 isolates included 4 species [Cronobacter sakazakii (52 isolates) Cronobacter malonaticus (14 isolates), Cronobacter dublinensis (7 isolates), and Cronobacter muytjensii (3 isolates)]. Twenty-three unique fusA alleles and sixty-six PFGE-patterns were detected. All isolated strains were observed to be sensitive or to show intermediate susceptibility to eight tested antimicrobial agents.

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